PPMI Screening Survey

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PPMI Screening Survey

Thank you for your interest in the Parkinson's Progression Markers Initiative (PPMI). Please complete the questions below to determine your next steps in the study. Learn more about PPMI and this screening form.

Your privacy is important to us. Any information you share in this study will be stored on secure servers and safeguarded by the highest research and privacy standards.

Have you been diagnosed with Parkinson's disease?

YesNo

What Year Were You Diagnosed with PD?

Do you have a first-degree relative (father, mother, full sibling, child) who has/had Parkinson's disease?

YesNoNot Sure

Are you of Eastern European (Ashkenazi) Jewish descent?

YesNoNot Sure

Has a health provider told you that you have a sleep problem called REM sleep behavior disorder?

YesNo

Some people act out dreams while they sleep. They may punch, kick, yell or even fall out of bed. Have you been told you act out your dreams? Or do you suspect you may do this?

YesNo

Birth Month

Birth Day

Birth Year

Gender

Country of Residence

City

State

Province

Postal Code

First Name

Last Name

Email Address

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Redirect Calculation

Age and Country Calculation

PD Rel + RBD + Dream

Ineligible

PPMI

Final Calculation

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Here. Until Parkinson's isn't.

Join us as we work to find a cure for the 6 million people worldwide living with Parkinson's.

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First Name

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Last Name

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Zip Code

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Date of Birth

Month

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Day

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Year

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Connection to Parkinson's

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What Year Were You Diagnosed with PD?

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